Funds to aid Arizona's mentally ill

'Medical home' program to provide physical-, behavioral-health care

by Mary K. Reinhart - Aug. 2, 2011 12:00 AMThe Arizona Republic

Arizonans with serious mental illness die more than 30 years earlier than the average state resident, and the vast majority of those deaths are preventable, stemming from obesity, smoking, asthma and lack of regular medical care.

Now, state and county health officials are joining a national effort to save lives and money by coordinating physical- and mental-health care.

Gov. Jan Brewer today will announce an agreement between Maricopa County's safety-net health-care system and Magellan Health Services, the county's behavioral-health administrator, that will put traditional doctors in mental-health clinics to tackle the chronic physical health problems of people with serious mental illness.

The move dovetails with a state effort, supported by a $500,000 federal planning grant, to create an integrated "medical home" for people with serious mental illness enrolled in the Arizona Health Care Cost Containment System, the state's Medicaid program.

The idea is to put one entity in charge of a person's health care, both medical and mental. Data sharing and on-site coordination between health professionals have been shown to reduce medication costs, identify untreated conditions, improve overall health care and keep people out of the hospital.

A one-stop shop is more comfortable for people with mental illness, who often avoid the typical doctor's office, let conditions go untreated and wind up in emergency rooms.

Christy Dye, CEO of Partners in Recovery, which provides behavioral-health-care services to thousands of county residents, said primary-care doctors also struggle.

"One of the real barriers has been stigma and the uneasiness in the health community in working with people who have a psychiatric disorder. So the connections don't happen," Dye said.

But since a primary-care physician joined their West Valley clinic in January, patients have been diagnosed with a variety of life-threatening medical conditions, including diabetes, reduced their prescription-drug intake and brought chronic health problems under control with diet, exercise and regular treatment.

"We're getting people who would otherwise not go to the doctor in to see a doctor," she said.

Dye said Magellan data shows that three-fourths of the 12,000 people with serious mental illness don't have a primary-care doctor. The partnership between Magellan and Maricopa Integrated Health Services is intended to change that.

"It has real power to absolutely revolutionize how the services get delivered and improve the lives of people," Dye said. "We can hardly wait to start."

Bill Rosenfeld has been honing the coordinated-care model for eight years at Mountain Park Health Center's five clinics as the director of integrated behavioral health. For most of their patients, he said, behavioral-health conditions are inexorably tied to their medical problems.

"The ramifications of our patients' behavioral decisions are huge in regards to managing disease," Rosenfeld said. "We've dedicated an entire crew to that and we've proven the outcomes."

He said the key is to ensure that the care coordination is immediate and "shoulder-to-shoulder" with physicians, as opposed to faxing information back and forth or putting a therapist in a back room for occasional consultations.

The state planning grant comes through federal health-reform funding, and states that establish pilot programs can get enhanced matching federal funds, reaping $9 for every $1 the state spends. Though Brewer has filed suit to repeal the 2010 health-care law, the "health-homes" grant is among several that the state has sought and won, including another to help plan for health-insurance exchanges.

State behavioral-health funding has been cut by more than $75 million over the past two years, not including a portion of the $500 million cut just imposed on AHCCCS last month.

AHCCCS Director Tom Betlach said layers of federal, state and county programs have made the system difficult to navigate, particularly for people with significant mental health problems.

"When you have so many entities that are responsible for that individual, nobody is responsible," Betlach said.

The promise of a streamlined, more efficient system that improves health care for some of Arizona's most vulnerable residents is a respite from what has been a tough fiscal slog.

"At a time when we've been having to do nothing but cut budgets," Betlach said, "this is an opportunity to change the system for the better."